Most popular over-the-counter (OTC) pain medications

The popularity of over-the-counter (OTC) pain medications can vary greatly based on location due to local regulations, marketing, and cultural preferences. However, as of my last training cut-off in September 2021, the most globally recognized and widely used OTC pain medications include:

  • Acetaminophen (Paracetamol): Also known under the brand name Tylenol and Panadol, it's used to treat mild to moderate pain and to reduce fever.
  • Ibuprofen: Known by brand names such as Advil and Nurofen, ibuprofen is an NSAID used to relieve pain, reduce inflammation, and lower fever.
  • Aspirin: Sold under various brand names such as Bayer, aspirin is used to relieve minor aches and pains, reduce fever, and in low doses, to prevent heart attacks.
  • Naproxen: Sold under the brand name Aleve among others, it is used for pain relief, fever reduction, and lowering inflammation.

The History of Acetaminophen

Acetaminophen, also known as paracetamol, has a fascinating history. Here's a brief overview:

  • 19th Century: The chemical structure of acetaminophen is similar to that of both quinine (an anti-malaria drug) and coal tar, both of which were in use during the 19th century. This was the time when researchers began to explore the chemistry and potential medicinal applications of coal tar derivatives. In 1877, Harmon Northrop Morse first synthesized acetaminophen.
  • Early 20th Century: Despite its synthesis in the late 19th century, the pain-relieving and fever-reducing properties of acetaminophen were not discovered until the early 20th century. Acetanilide was used as a fever reducer, but it had serious side effects, including cyanosis due to methemoglobinemia. Researchers discovered that the active metabolite with the desired properties was acetaminophen, which did not have the same risks.
  • Mid 20th Century: Acetaminophen was first marketed in the United States in 1955 by Sterling-Winthrop Co. as a solution for children under the name Tempra. The product was advertised as being "safe for use in children", highlighting its safety compared to aspirin.
  • 1960s and Beyond: Acetaminophen became widely available over-the-counter in the 1960s and began being marketed under the brand name Tylenol. Its popularity grew over time, particularly as concerns about the safety of aspirin grew. In particular, it was found that aspirin was linked to Reye's syndrome in children, and gastrointestinal bleeding in adults. As a result, acetaminophen's reputation as a safer alternative contributed to its popularity.
  • 1982 Tylenol Murders: A major event in the history of acetaminophen was the Tylenol Murders in the United States in 1982, where seven people died after taking Tylenol capsules that had been laced with cyanide. This led to widespread fear and a temporary removal of the product from the market. However, it also led to significant changes in packaging standards for over-the-counter medication to prevent tampering, with induction seals and tamper-evident packaging becoming standard.
  • 21st Century: Despite the occasional safety concerns (particularly related to liver damage from overdose or chronic use), acetaminophen remains one of the most commonly used over-the-counter medications for pain and fever reduction into the 21st century. Its use and safety continue to be the subject of research and regulatory scrutiny.

The History of Ibuprofen

Ibuprofen, a common nonsteroidal anti-inflammatory drug (NSAID) used for relieving pain, reducing inflammation, and lowering fever, also has an interesting history:

  • 1960s: Ibuprofen was developed by a research team from the British pharmaceutical company Boots Group. The team was led by Dr. Stewart Adams, with significant contributions from his colleagues John Nicholson and Colin Burrows, and began their research in the 1950s. They were investigating compounds to treat rheumatoid arthritis, with the hope of finding a safer and more effective alternative to the drugs available at the time. They synthesized ibuprofen (originally named Brufen) and it was patented in 1961.
  • 1969: Ibuprofen was first launched in the UK in 1969 as a prescription drug for treating conditions like rheumatoid arthritis under the brand name Brufen.
  • Over-the-Counter Availability: The FDA approved ibuprofen as a prescription medication in the United States in 1974. It was marketed under various brand names, including Motrin. Ibuprofen was later approved for over-the-counter (OTC) sale, and the first OTC ibuprofen, under the brand name Advil, was available in 1984.
  • 21st Century: Today, ibuprofen is one of the most common OTC pain relievers used worldwide. It's available under several brand names, including Advil, Motrin, and Nurofen, as well as in generic form.

The History of Aspirin

Aspirin, also known by its chemical name acetylsalicylic acid, has a storied history that spans thousands of years:

  • Ancient History: The medicinal use of plants containing salicylate (a chemical precursor to aspirin) dates back thousands of years. For example, Hippocrates, a Greek physician in the 5th century BC, wrote about using willow bark and leaves (which are rich in salicylates) to alleviate pain and fever.
  • 19th Century: In the mid-19th century, chemists began synthesizing salicylate-rich plants to create pain relievers. The first person to create pure salicylic acid was Italian chemist Raffaele Piria in 1838. However, while salicylic acid was effective for reducing pain and fever, it was also hard on the stomach.
  • Creation of Aspirin: In 1897, Felix Hoffmann, a chemist working at Bayer in Germany, created a less harmful version of salicylic acid, known as acetylsalicylic acid. Hoffmann was looking for a medication to ease his father's arthritis pain. Bayer began selling this new drug as Aspirin in 1899.
  • 20th Century: For the first few decades of the 20th century, aspirin was one of the most popular pain relievers worldwide. However, its use declined in the 1950s and 1960s with the introduction of other nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and acetaminophen.
  • Late 20th Century - Present: In the 1970s and 1980s, researchers discovered that low doses of aspirin could reduce the risk of heart attacks and strokes. Since then, many people take low-dose aspirin as a preventive measure against cardiovascular disease.

The History of Naproxen

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relieve pain, reduce inflammation, and lower fever. It's often used for conditions such as arthritis, gout, menstrual cramps, and general pain relief. Here's a brief history of naproxen:

  • Early Development: Naproxen was developed by the American pharmaceutical company Syntex. Syntex was a leader in developing NSAIDs: they had previously synthesized cortisone and were the original developers of another well-known NSAID, ibuprofen.
  • 1976: The U.S. Food and Drug Administration (FDA) first approved naproxen as a prescription drug in 1976. It was marketed under the brand name Naprosyn.
  • Over-the-Counter Availability: In 1994, the FDA approved a lower-dose version of naproxen for over-the-counter (OTC) sale, and it was marketed under the brand name Aleve. OTC naproxen is typically used for temporary relief of minor aches and pains, and to reduce fever.
  • 21st Century: Today, naproxen is widely available both OTC and as a prescription drug. Prescription-strength naproxen is often used to treat conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and gout.

The lesser known OTC pain medications

  • Ketoprofen: This is another type of nonsteroidal anti-inflammatory drug (NSAID). It's similar to ibuprofen and naproxen, and it's used to relieve pain, inflammation, and fever. Although it's not as widely available OTC as some other NSAIDs, it's available without a prescription in some countries.
  • Diphenhydramine: This is an antihistamine, commonly known under the brand name Benadryl, and while it's primarily used to relieve allergy symptoms, it also has sedative properties. Because of this, it's often used in combination with other pain relievers in "nighttime" or "PM" versions of these medications to help users sleep.
  • Menthol and Capsaicin: These are often used in topical pain relievers. They're applied to the skin to relieve minor aches and pains, often those associated with conditions like arthritis or muscle strains.
  • Magnesium Salicylate: This is another NSAID that's sometimes used for minor pain relief. It's sold under the brand name Doan's, among others.

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